Alcohol drinking modified the effect of plasma YKL-40 levels on stroke-specific mortality of acute ischemic stroke.

OBJECTIVES: Our study aimed to evaluate the association between plasma human cartilage glycoprotein-39 (YKL-40) and stroke-specific mortality at two years in acute ischemic stroke patients according to the drinking status and amount of alcohol consumption. We further investigated the effect of the interaction between these conditions and YKL-40 levels on the outcome. METHODS: We measured plasma YKL-40 levels in 3267 participants from the China Antihypertensive Trial in Acute Ischemic Stroke. Outcome data on stroke-specific mortality were collected at two years after stroke onset. RESULTS: During the two years of follow-up, 208 (6.4 %) patients, including 44 drinkers and 164 nondrinkers, died of stroke-specific causes. The patients in the highest quartile of YKL-40 had a 3.52-fold (95 % CI: 1.15-10.76, P for trend = 0.006) risk of stroke-specific mortality compared with those in the lowest quartile among drinkers. However, no significant association between YKL-40 and the outcome was observed among nondrinkers (HR: 1.18, 95 % CI: 0.75-1.86, P for trend = 0.08). Alcohol drinking modified the effect of YKL-40 on the outcome (P for interaction = 0.04). Subgroup analyses revealed that each 1-unit increase in log-transformed YKL-40 was associated with a 72 % greater risk of stroke-specific mortality for light drinkers. This association was amplified with a 226 % increased risk of the outcome among heavy drinkers. CONCLUSIONS: Elevated YKL-40 levels were associated with an increased risk of stroke-specific mortality at two years among drinkers with ischemic stroke. Drinking status substantially modified the effect of plasma YKL-40 levels on the outcome. This effect was amplified with the increased amount of alcohol consumption. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT01840072.

Application value of EV/EV71/CA16-SAT detection in children with hand-foot-mouth disease.

The objective of this work was to explore the application value of a new type of fluorescent nucleic acid isothermal amplification (SAT) to detect EV/EV71/CA16-SAT in children with hand-foot-mouth disease (HFMD). For this purpose, from March 2017 to September 2019, Chengdu Children's Specialized Hospital collected throat swabs from children with clinical manifestations of hand, foot and mouth disease, and used SAT technology to screen and detect universal enterovirus (EV) nucleic acid (There were 1860 children with EV-RNA) positive. Patients who are EV-RNA positive at any time: first use the same throat swab specimen to detect EV71/CA16-RNA; secondly, collect venous blood and use the colloidal gold method to detect IgM antibodies in EV71/CA16 serum. The patients with positive EV71/CA16-RNA or EV71/CA16-IgM (or both) were repeated the above two methods 2 weeks and 4 weeks after standard treatment for review and comprehensive analysis. Results showed that 763 cases were enrolled for the first time: 59.76% were male and 40.24% were female; the age ranged from 1 month to 13 years, of which 69.06% were from 1 to 4 years old; CA16-RNA positive 56.23%, EV71-RNA positive 21.89%, CA16/EV71 -RNA were all positive in 1.57%; CA16-IgM was positive in 64.48%, EV71-IgM was positive in 54.26%, and CA16/EV71-IgM were both positive in 18.74%. After 2 weeks, 722 cases were reexamined: 26.73% were positive for CA16-RNA, 7.89% were positive for EV71-RNA, 0.28% were both positive for CA16/EV71-RNA; 66.21% were positive for CA16-IgM, 51.52% were positive for EV71-IgM, and IgM were all positive in 17.73%. Four weeks later, 489 cases were reexamined: among them, CA16-RNA positive 5.73% of which were positive for EV71 color RNA (0.005%), and 12.68% of them were all positive for EV71lym. The strategy of combining SAT technology and colloidal gold method to detect EV/EV71/CA16 nucleic acid (RNA) and serum IgM antibody in children HFMD can improve the early detection rate and accuracy of HFMD; According to the comprehensive analysis of the detection results of children with HFMD at the early stage, 2 weeks and 4 weeks of the present study, it is suggested that EV/EV71/CA16-SAT nucleic acid detection can be used to judge the prognosis, follow-up treatment, set isolation time, return students to school, and community management in children with HFMD. and prevention and control have more clinical application value.

Tracing the sources of PM2.5-related health burden in China.

Fine particulate matter (PM2.5) poses a major environmental risk to human health. We estimated PM2.5-related premature deaths in 30 Chinese provinces in 2020 using an integrated exposure response model based on monitored concentrations and obtained regional and sectoral contributions based on the atmospheric transport of the atmospheric transport contribution matrix. From the perspective of regional- and sectoral-scale effects, the results revealed that 740,140 [95% confidence interval (CI):646,538-839,968] premature deaths were related to PM2.5 in 2020, mainly in East (30%), Central (18%), and North (15%) China. Manufacturing activity was found to be the major cause of PM2.5-related premature deaths, accounting for over 50% of the deaths. From the perspective of the interregional atmospheric transport effect, although local emissions were the major source of PM2.5-related premature deaths in all regions, non-local emissions contributed approximately 30%. The overall trend in the net atmospheric transport direction was from north to south. In particular, the Guangdong, Guangxi, and Hainan provinces of South China received contributions of more than 40% from non-local provinces, mainly from the East and Central China. Combined with economic data, the regions and sectors with the highest PM2.5-related premature deaths per unit output or consumption include the manufacturing and household sectors in North and Northeast China and transportation, agriculture, and electricity in Central China. Therefore, from the perspective of the above three impacts, although the potential impact of PM2.5 pollution on health in China has decreased with the decrease in PM2.5 concentration in the past decade owing to strict air pollution control, the central and northern parts of China are still the key areas requiring air pollution control. The health impacts of air pollution associated with the rapid development of China's manufacturing industry in the post-pandemic era cannot be ignored.

[Coal-carbon-pollutant Coordinated Control of Coal Chemical Industry Under Carbon Peak and Carbon Neutrality Constraints].

Under carbon peak and carbon neutrality constraints, the coal chemical industry should take stricter measures to tackle carbon reduction. Based on the intensity differences of five major coal and carbon reduction measures applied by the coal chemical industry, which include raw material structure adjustment, fuel structure adjustment, energy-saving technology transformation, terminal capture technology, and industrial structure adjustment, this study adopted the downstream sector demand method and project method, combined with the air pollution reduction model, to predict three scenarios (benchmark, policy, and enhancement) of coal chemical industry peak year and peak amount of coal consumption and carbon dioxide emission, associated with air pollutant reduction row effects. The results showed that coal consumption under the benchmark and policy scenarios of the coal chemical industry is expected to reach a peak in the late period of China's "14th Five-Year Plan", with peak values of 0.96 billion and 0.93 billion tons, respectively. By contrast, under the enhanced scenario, it is expected to peak in the early period of the "14th Five-Year Plan" with a value of 0.91 billion tons. The carbon peak will arrive in the late period of the "15th Five-Year Plan" under the benchmark scenario but in the early and late period of the "14th Five-Year Plan" under the policy and enhanced scenarios, with peak values of approximately 0.64 billion, 0.57 billion, and 0.55 billion tons, respectively. Controlling the construction scale of new coal chemical projects, tapping the space for raw material substitution, and speeding up the energy-saving technological transformation are important measures for coal and carbon control in the coal chemical industry. The implementation of coal and carbon reduction measures of the coal chemical industry will coordinately reduce air pollutant emissions, such as SO2, NOx, PM, and VOCs by 37, 43, 11, and 28 thousand tons per year after 2035.

Public Concern about Haze and Ozone in the Era of Their Coordinated Control in China.

In China, due to the implementation of the Action Plan for Prevention and Control of Air Pollution (APPCAP), the concentrations of PM2.5 (fine particulate matter) and severe haze in most cities have decreased significantly. However, at present, haze pollution in China has not been completely mitigated, and the problem of O3 (ozone) has become prominent. Therefore, the prevention and control of haze and O3 pollution have become important and noticeable issues in the field of atmospheric management. We used the Baidu search indices of "haze" and "ozone" to reflect public concerns about air quality and uncover different correlations between level of concern and level of pollution, and then we identified regions in China that require public attention. The results showed that (1) over the last decade, the search index of haze had a rapid trend of variation in line with changes in haze pollution, but that of O3 had a relatively slowly increasing trend; (2) the lag days between the peaks of public concern and the peaks of air pollution became increasingly shorter according to daily data analysis; and (3) 96 polluted cities did not receive sufficient public attention. Although periods of heavily haze-polluted weather, which affects visibility, have generated much public concern, periods of slight pollution have not received enough public attention. Public health protection and environmental participation regarding these periods of slight pollution in China deserve appropriate levels of attention.

Worsening Carbon Inequality Embodied in Trade within China.

The mismatch between trade-embodied economic benefits and CO2 emissions causes carbon inequality, which is seldom analyzed from the intracountry level, especially across a long-term period. This study applied an environmentally extended multiregional input-output model to trace this mismatch and measure the carbon inequality quantitatively within China during 2007-2017. The results show that during the past decade, China's national carbon inequality was continuously worsening with carbon Gini coefficients rising regardless of production- (0.21-0.30) or consumption-based (0.12-0.18) accounting. The regional carbon inequality was deteriorating, where less developed provinces with 20% of total value-added emitted 32.9% of total CO2 emissions in 2007, while this figure rose to 42.6% in 2017. The eastern provinces (Jiangsu and Shanghai) had entered into net economic and carbon beneficiaries keeping high trade advantages, by contrast the northwest provinces (Ningxia and Xinjiang) were trapped in a lose-lose situation with trade benefits declining by 68%. The southwest provinces (Yunnan and Guangxi) shifted from being net carbon and value-added exporters to net importers, stepping into the earlier development mode of eastern provinces. This hidden and exacerbated carbon inequality calls for regional-specific measures to avoid the dilemma of economic development and CO2 mitigation, which also gives a good reminder for the rising economies, like India.

Consumption-based emissions at city level in China and the spatial heterogeneity analysis of the influential factors.

It is of great significance to identify the critical influential factors of pollutant emissions for emission mitigation. However, city disparity implies different priorities for regional mitigation. This study aims to estimate the consumption-based emissions of 309 prefecture-level cities in China based on the multi-region input-output table and the sectoral NOx emission inventory and investigate the emission transfer phenomenon among cities and sectors. In addition, a geographically weighted regression method is used to analyze the spatial heterogeneity in the driving factors of regional consumption-based emissions. The results reveal that the top 10 cities in consumption-based emissions account for 25.2% of emissions and contribute 22.6% to GDP. The consumption-based emissions are mainly driven by local demand (72.79%) at the regional level and by construction activities (94.43%) at the sectoral level. Besides, the results also show the spatial variances in contributions of driving forces to consumption-based emissions. Economic growth has been identified as the most important factor which promotes consumption-based emissions. However, disposable personal income, per capita road area, urbanization, and percentage of tertiary industry GDP are conducive to reduce consumption-based emissions in some cities of China. It could be concluded that policies without consideration of the emissions from a consumption perspective are difficult to achieve effective emission reduction.

Are the Benefits of a High-Emission Vehicle Driving Area Restriction Policy Greater than the Costs?

China implemented a vehicle driving area restriction policy to control air pollution by delimiting a no-driving area for high-emission vehicles (HEVs). Current academic research does not evaluate the benefits and costs of this policy based on vehicle level and lacks evidence at the regional level. Therefore, a cost-benefit analysis method is developed to evaluate the benefits and the costs of this policy, based on 2.128 million HEVs in the Beijing-Tianjin-Hebei (BTH) region from 2008 to 2015. The benefits, the costs, and net benefits of this policy were CNY 98.49, CNY 5.80 and CNY 92.69 billion. The cost-benefit ratios of the BTH region, Beijing, Tianjin and Hebei were 1:16.98, 1:20.88, 1:14.52 and 1:16.55, respectively. Beijing's cost-benefit ratio was the maximum at the city scale. This work can provide scientific support for promoting driving area restriction policies on older gasoline vehicles and older diesel vehicles, the improvement of cost-benefit analysis and efficient decision-making for the Chinese government.

Optimization of Emission Reduction Target in the Beijing-Tianjin-Hebei Region: An Atmospheric Transfer Coefficient Matrix Perspective.

In recent years, the problem of atmospheric pollution has been concerning in the Beijing-Tianjin-Hebei region, due to the frequent haze. It has become a significant issue to improve regional air quality through appropriate emission reduction measures. In this study, considering the regional atmospheric transmission of air pollutants, the WRF/CALPUFF model (the Weather Research and Forecasting model coupled with the California Puff air quality model) was used to describe the impact of each city's pollutant emissions on the concentrations of every city. Then, a new optimization model was designed to calculate the maximum allowable emissions of every city. The results showed that NOx and PM2.5 emissions need to be reduced by 44% and 48%, respectively, in the traditional mitigation scenario (any city's pollutant emissions are not allowed to increase). However, in the optimized scenario, NOx and PM2.5 emissions should be reduced by 23% and 46%, respectively, to meet the national secondary standard. The emissions of cities with low transfer coefficients, such as Zhangjiakou, Qinhuangdao, and Chengde, could even be appropriately increased. This means that the optimized scenario could reduce the pressure on emission reduction. Although the optimization results are theoretical and idealistic, this research study provides a new idea for formulating emission mitigation policies in various regions to reduce the impact on the economy.

Plasma Human Cartilage Glycoprotein-39 Is Associated With the Prognosis of Acute Ischemic Stroke.

Background To evaluate the prognostic value of plasma YKL-40 (human cartilage glycoprotein-39) for acute ischemic stroke. Methods and Results We measured plasma YKL-40 levels in 3377 participants from CATIS (China Antihypertensive Trial in Acute Ischemic Stroke). Study outcome data on death, major disability (modified Rankin Scale score ≥3), and vascular diseases were collected at 3 months after stroke onset. The primary outcome was defined as a combination of death and major disability. During the 3-month follow-up, 828 participants (24.5%) experienced major disability or died. After multivariate adjustment, the highest YKL-40 quartile was associated with an increased risk of the primary outcome (odds ratio, 1.426 [95% CI, 1.105-1.839]; Ptrend=0.01) compared with the lowest quartile. Each SD increase in log-transformed YKL-40 level was associated with a 15.5% (95% CI, 5.6-26.3%) increased risk of the primary outcome. The multivariable-adjusted spline regression models showed a linear dose-response relationship between YKL-40 and clinical outcomes. Adding YKL-40 to a model containing conventional risk factors significantly improved the reclassification power for the primary outcome (net reclassification improvement: 15.61%, P<0.001; integrated discrimination index: 0.37%, P=0.004) and marginally significantly improved the discriminatory power for the primary outcome (area under the receiver operating characteristic curve improved by 0.003, P=0.099). Conclusions A higher YKL-40 level in the acute phase of ischemic stroke was associated with an increased risk of mortality and major disability at 3 months after stroke, indicating that YKL-40 may play an important role as a prognostic marker of ischemic stroke. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01840072.

Plasma neuropeptide Y and cognitive impairment after acute ischemic stroke.

BACKGROUND AND PURPOSE: Neuropeptide Y (NPY) has a modulatory role in learning and memory, and is involved in the pathophysiology of neurodegenerative diseases. However, there was no population-based evidence on the relationship between NPY and post-stroke cognitive impairment (PSCI). We aimed to prospectively examine the association between plasma NPY and cognitive impairment among patients with acute ischemic stroke. METHODS: On the basis of samples from the China Antihypertensive Trial in Acute Ischemic Stroke, 593 patients with baseline plasma NPY levels were finally included in this study. The study outcome was cognitive impairment (Montreal Cognitive Assessment score < 26) at 3 months after ischemic stroke. Logistic regression models were used to estimate the risk of cognitive impairment. RESULTS: After 3 months of follow-up, 422 participants (71.2 %) experienced cognitive impairment. Multivariable-adjusted odds ratio (95 % confidence interval) for the highest tertile of NPY was 0.58 (0.36-0.92) compared with the lowest tertile. Each 1-SD higher log-NPY was associated with a decreased risk of 20 % (95 % confidence interval 2 %-34 %) for PSCI. The addition of plasma NPY to the basic model with conventional risk factors improved the risk reclassification (continuous net reclassification index was 22.8 %, p = 0.01; integrated discrimination improvement was 0.9 %, p = 0.02) for PSCI. LIMITATIONS: We measured plasma NPY only once at baseline and failed to explore the association between NPY changes and PSCI. CONCLUSIONS: Elevated plasma NPY levels were associated with a decreased risk of cognitive impairment, suggesting plasma NPY may serve as a predictive factor and potential therapeutic target for PSCI.

A bibliometric analysis of cancer research funders and collaborators in Kenya: 2007-2017.

AIM: Cancer research is essential to the development and implementation of effective control strategies and interventions. In Kenya, cancer is the third leading cause of death. Country specific research conducted by local and international investigators can inform a national plan to address local needs across the cancer care continuum. This analysis aims to provide information about the trends and types of cancer research collaborations, funding, and outputs from 2007 to 2017, to understand gaps and opportunities to strengthen Kenya-led cancer research capacity. METHODS: This analysis included 243 studies from a previously published phase 1 scoping review of oncology research conducted and published in Kenya from 2007 to 2017. The citation metadata was drawn from the Web of Science and PubMed and normalized in Microsoft Excel. Using Sci2, a series of bibliometric network analyses were conducted to identify funding patterns, collaborations between authors and institutions, and the types of cancer research conducted in Kenya. Gephi and Excel provided descriptive analyses and graphs of the network. The analyses are categorized into three themes: article production, collaboration, and research topics. RESULTS: The bibliometric analysis found 5 US-based government agencies are funding cancer research in Kenya. Kenya-Kenya institutional collaborations were most common, and half of authors with the most co-authored publications were from Kenya. The publication trend showed a gradual increase from 2011 to 2014 with a subsequent drop through 2017. CONCLUSION AND POLICY SUMMARY STATEMENT: This study identifies the funders and most often published Kenyan authors and Kenyan-based institutions publishing oncology research in Kenya. It also identifies future areas to focus research and the importance of continuing to build the writing and publishing capacity on oncology research by Kenyans.

Soluble TREM2 is associated with death and cardiovascular events after acute ischemic stroke: an observational study from CATIS.

BACKGROUND: Soluble triggering receptor expressed on myeloid cells 2 (sTREM2), which reflects microglia activation, has been reported closely associated with neuronal injury and neuroinflammation. We aimed to prospectively investigate the associations between plasma sTREM2 and clinical outcomes in acute ischemic stroke (AIS) patients. METHODS: Study participants were from the China Antihypertensive Trial in Acute Ischemic Stroke, plasma sTREM2 levels in the acute phase of AIS were measured in 3285 participants. The study outcomes were death, cardiovascular events and severe disability at 1 year after AIS. Cox proportional hazards models or logistic regression models were performed to examine the associations of plasma sTREM2 and clinical outcomes. RESULTS: After 1-year follow-up, 288 participants (8.8%) experienced cardiovascular events or died. Multivariable-adjusted hazard ratios or odds ratios (95% confidence intervals) for the highest quartile of sTREM2 were 1.57 (1.11-2.21) for the composite outcome of death and cardiovascular events, 1.68 (1.09-2.60) for death, and 1.53 (1.08-2.18) for death or severe disability compared to the lowest quartile. Moreover, incorporation sTREM2 into traditional risk factors model significantly improved risk prediction of the composite outcome of death and cardiovascular events as evidenced by net reclassification index and integrated discrimination improvement (all p values < 0.05). There were joint effects of sTREM2 and galectin-3 on death and cardiovascular events. Participants with simultaneous elevation of sTREM2 and galectin-3 levels had the highest risk of the composite outcome of death and cardiovascular events. CONCLUSIONS: Elevated sTREM2 levels were independently associated with increased risks of death and cardiovascular events after AIS.

The association between plasma soluble triggering receptor expressed on myeloid cells 2 and cognitive impairment after acute ischemic stroke.

BACKGROUND: Previous researches have suggested that soluble triggering receptor expressed on myeloid cells 2 (sTREM2) plays a pivotal role in central nervous system pathologies and the development of neurodegenerative disorders. This study aimed to prospectively investigate the association between plasma sTREM2 levels and post-stroke cognitive impairment (PSCI). METHODS: A sample of 599 consecutive acute ischemic stroke patients with sTREM2 measurements from the China Antihypertensive Trial in Acute Ischemic Stroke were eventually included in this analysis. Cognitive impairment was defined as a score of <25 for Mini-Mental State Examination, measured at 3-month follow up. Binary logistic regression was used to estimate the odds ratios (ORs) of plasma sTREM2 levels on the risk of PSCI. RESULTS: Of the 599 participants (mean age, 60.0 ± 10.4 years; male, 70.5%), 228 (38.1%) patients were diagnosed as PSCI. The risk of PSCI elevated significantly with higher plasma sTREM2 levels (p for trend <0.01). After adjusting for several confounding factors, the ORs for the highest quartile of sTREM2 compared with the lowest quartile was 2.06 (95% confidence interval, 1.20-3.53) for PSCI. Moreover, the addition of sTREM2 to the conventional model with established risk factors significantly improved risk discrimination (C-statistics increased from 0.668 to 0.691, p = 0.02) and reclassification (net reclassification improvement: 32.2%, p < 0.001; integrated discrimination improvement: 1.3%, p = 0.01) for PSCI. LIMITATIONS: Results might be subject to selective bias and potential confounding. CONCLUSIONS: The present study demonstrated that elevated level of plasma sTREM2 may be associated with PSCI, and sTREM2 has potential value in predicting PSCI.

A Data-Based Approach to Evaluating Representation by Gender and Affiliation in Key Presentation Formats at the Annual Meeting of the Society for Epidemiologic Research.

The annual meeting of the Society for Epidemiologic Research (SER) is a major forum for sharing new research and promoting the career development of participants. Because of this, evaluating representation in key presentation formats is critical. For the 3,257 presentations identified at the 2015-2017 SER annual meetings, we evaluated presenter characteristics, including gender, affiliation, subject area, and h-index, and representation in 3 highlighted presentation formats: platform talks (n = 382), invited symposium talks (n = 273), and chairing a concurrent contributed session or symposium (n = 188). Data were abstracted from SER records, abstract booklets, and programs. Gender was assessed using GenderChecker software, and h-index was determined using the Scopus application programming interface. Log-binomial models were adjusted for participant characteristics and conference year. In adjusted models, women were less likely than men to present an invited symposium talk (relative risk = 0.60, 95% confidence interval: 0.45, 0.81) compared with all participants with accepted abstracts. Researchers from US public universities, US government institutions, and international institutions were less likely to present a symposium talk or to chair a concurrent contributed session or symposium than were researchers from US private institutions. The research areas that were most represented in platform talks were epidemiologic methods, social epidemiology, and cardiovascular epidemiology. Our findings suggest differences in representation by gender, affiliation, and subject area after accounting for h-index.

Occupational class differences in outcomes after ischemic stroke: a prospective observational study.

BACKGROUND: Occupational class is an integral part of socioeconomic status. The studies focused on the occupational difference in ischemic stroke outcome in a Chinese population are limited. We aimed to investigate the associations between occupational class and the prognosis of patients with ischemic stroke in China. METHODS: We included 1484 ischemic stroke participants (mean age: 63.42 ± 11.26 years) from the prospective cohort study: Infectious Factors, Inflammatory Markers and Prognosis of Acute Ischemic Stroke (IIPAIS). Occupational class was categorized into white-collar workers, blue-collar workers and farmers in our study. Study outcomes were cardiovascular events and all-cause mortality within 12 months after ischemic stroke onset. We applied Cox proportional hazard model to evaluate the associations between the occupational class and study outcomes after ischemic stroke. RESULTS: Within 12 months after ischemic stroke, there were 106 (7.5%) cardiovascular events and 69 (4.9%) all-cause deaths. The Kaplan-Meier plots showed that white-collar workers had highest risk of cardiovascular events after 12-month follow-up (Log-rank P = 0.02). Multivariate adjusted hazard ratio and 95% confidence intervals (CIs) of farmers versus white-collar workers was 0.43(0.20-0.91) for cardiovascular events. No significant difference showed in blue-collar workers versus white-collar workers, with fully adjusted hazard ratio 0.62(95% CIs, 0.23-1.67). CONCLUSIONS: Compared with white-collar workers, farmers are associated with less risk of cardiovascular events at 12 months after ischemic stroke, while there are no significant differences in blue-collar workers.

[Distribution Characteristics and Ecological Risk Assessment of Soil Heavy Metals in Typical Watersheds of the Qinghai-Tibet Plateau].

The Qinghai-Tibet Plateau is an extremely vulnerable area that is sensitive to human activities. In recent years, more and more human disturbances have been detected in this area. This study analyzed the spatial distribution and ecological risks of 7 heavy metals (Cr, Ni, Cu, Zn, As, Cd, and Pb) in two regions, namely the Bailong River and Yellow River and their two tributaries (BY region) in Gannan and the Yarlung Zangbo River and its two tributaries (YZ region) in Tibet. In terms of spatial distribution, concentrations of the seven heavy metals were higher in the east and lower in the west of the BY region. The average concentrations all exceeded the background value of the Qinghai-Tibet Plateau, especially for Cd (4.50 times) and As (2.83 times). High Pb concentrations were mainly found in water, urban and rural residential land, and industrial and construction land. In the YZ region, heavy metal concentrations were lower along the river, while high-altitude areas exhibited higher heavy metal concentrations. The average concentrations of Ni, Zn, As, and Cd exceeded the background values of the Qinghai-Tibet Plateau, especially that of Cd (3.13 times), which mostly exhibited high values in water coverage areas. The geo-accumulation index method and the potential ecological risk index method show that the degree of As and Cd pollution was relatively high in the BY region in Gannan, with the greatest potential ecological risk occurring in the water coverage area. In the YZ region in Tibet, the degree of Cd pollution was high, with the highest potential ecological risk also occurring in the water coverage area. This study provides significant guidance for the environmental protection, sustainable development, and utilization of soil under different types of land use in the Qinghai-Tibet Plateau.

Soluble ST2 and risk of cognitive impairment after acute ischemic stroke: a prospective observational study.

BACKGROUND: Soluble suppression of tumorigenesis-2 (sST2) was reported to be associated with cognitive performance and risk of incident stroke. However, the impact of sST2 on cognitive function after ischemic stroke is unclear. We aimed to assess the association of sST2 and cognitive impairment at 3 months in acute ischemic stroke patients. METHODS: Baseline plasma sST2 levels were measured in 619 ischemic stroke patients (mean age: 60.0 ± 10.5 years) from 7 participating hospitals of the China Antihypertensive Trial in Acute Ischemic Stroke. Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) were used to assess cognitive status. Cognitive impairment was defined as a MoCA score < 23 or MMSE score < 27. The association between sST2 and cognitive impairment was evaluated by logistic regression analysis. RESULTS: 325 (52.5%) or 323 (52.2%) participants developed cognitive impairment according to MoCA or MMSE. After adjustment for age, sex, education, and other covariates, the odds ratio for the highest vs lowest quartile of sST2 was 2.38 (95% CI, 1.42-4.00) and 1.82 (95% CI 1.09-3.03) risk of cognitive impairment defined by MoCA and MMSE score, respectively. Incorporation sST2 into a model containing conventional risk factors significantly improved reclassification. CONCLUSIONS: Elevated plasma sST2 levels were significantly associated with post-stroke cognitive impairment.

[Economic Benefit of Air Quality Improvement During Implementation of the Air Pollution Prevention and Control Action Plan in Beijing].

Air quality in Beijing has been improved significantly since the implementation of the Air Pollution Prevention and Control Action Plan ('Action Plan'). To evaluate the effect of the Action Plan, the cost-of-illness, human capital, and market value approaches were used to estimate air quality improvement benefits including human health, agriculture, building materials, and cleanliness. The policy benefit through monetization was also evaluated, which can affirm the positive effect of air pollution prevention and control by local government. The results illustrated that:① Since the policy implementation, air quality in Beijing has improved significantly and the improvement efficiency had been growing steadily. From 2013 to 2017, air quality had reached -1.982, -1.893, 15.707, 15.264, and 22.330 billion yuan respectively, accounting for -0.85‰, -0.81‰, 6.68‰, 6.16‰, and 8.77‰ of GDP in the fiscal year. The total profit during the five years was 49.426 billion yuan, accounting for 4.11‰ of the 5-year total GDP; ② The total improvement benefit was mainly linked to reductions in health and cleaning costs, primarily associated with a reduction in particulate matter concentrations; and ③ The majority of 16 administrative regions in Beijing reached an ideal level of benefit during the late stages of policy implementation, including Yanqing, Miyun, Pinggu, Changping, Tongzhou, Shijingshan, and Chaoyang Districts, which have retained a positive improvement index for five years. In contrast, Chaoyang and Haidian Districts have benefited relatively little as a result of the exposure of high-density populations to atmospheric pollution. These research results demonstrate the effectiveness and necessity of the Air Pollution Prevention and Control Action Plan in Beijing.